2009 Volume 18 Issue 2 Pages 134-141
The first national guideline for breast cancer screening, established in 1987, endorsed the use of clinical breast examination (CBE) without mammography in women aged 30 and over in Japan. However, subsequent studies conducted in Japan indicated that mammographic screening gave better sensitivity and an earlier stage distribution at detection of breast cancer, similar to that in Europe and the United States. An endorsement of mammography for women aged 40 and over was issued by the Ministry of Health, Labour and Welfare in 2004. The most important issue currently is to increase the breast cancer screening participation rate in Japan. If the participation rate were to improve, screening would have a higher risk of harm if the recall rate was high. To reduce the recall rate while maintaining high sensitivity, simultaneous CBE while reading mammograms would be effective. The policy is that the fat density area on the mammogram does not require further examination if it is palpable upon CBE. The recall rate for CBE alone was reduced from 1.0% to 0.7% by using CBE during mammography. In addition, this approach is able to improve the sensitivity when careful palpation was performed for the high-density area on the mammogram. To reduce the recall rate for mammography alone, a third reading for cases where the judgment of the second reader differs from the first is also effective.
